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Received Jun 21, 2017; Accepted Aug 29, 2017
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1. Introduction
Medication-related osteonecrosis of the jaws (MRONJ) is a critical clinical problem which is characterized by the progressive destruction and death of bone tissue of the jaws as a consequence of antiresorptive drug administration. So far the understanding of the mechanism and pathogenesis is still inadequate to justify the most effective treatment of MRONJ. Surgical intervention such as tooth extraction was reported to be a significant triggering factor in inducing MRONJ [1, 2]. However, more recent data proves that tooth extractions are not causative; it is important to realize that severe odontogenic infectious diseases, such as dental caries and periodontal diseases [3], accounted for over 50% of tooth extractions. In addition, oral preventive measures were stated to significantly decrease the incidence of MRONJ, which in turn emphasizes the significance of dental disease in its pathogenesis. This leads to the clinical question of whether the treatment of the diseased condition or the diseased condition itself is the etiological factor of MRONJ.
Clinical studies have revealed potential relevance between uncontrolled periodontitis and MRONJ [4, 5]. This finding was also confirmed by animal experiments including our recent studies [6–8]. Periodontal diseases are anatomically more superficial since the infection is mainly confined to the periodontal pocket and adjacent bone tissue. Periapical disease as a result of dental caries is also among the highest prevalence dental diseases. In contrast to periodontitis, periapical disease may introduce bacteria deeper into the alveolar bone through the root canal systems. It is therefore reasonable to hypothesize that periapical infection may play a role in the development of MRONJ.
The objective of this study was to investigate the role of periapical disease in inducing MRONJ using an ovariectomized (OVX) mouse model.
2. Materials and Methods
2.1. Animal Care and Surgery